Reclaiming Midwives: Pillars of Community Support
      (November 14, 2005 - April 2, 2006)

Anacostia Museum and Center for African American History and Culture, Washington, DC

Smithsonian Institution

Linda Janet Holmes, Exhibit Curator

Nursing rating		Rating guide: excellent = 4 stars; good = 3 stars; fair = 2 stars, poor = 1 star
Artistic rating

"Reclaiming Midwives" is a moving tribute to African-American lay midwives in the South. The multi-media exhibit does a fine job of placing the midwives in a community context, with a focus on their social and cultural importance. Three accompanying contemporary art exhibits celebrate the bonds among black women and their children. The main exhibit might have taken a closer look at the midwives' actual care, particularly its non-cultural merits under modern scientific models. The exhibit makes clear that nurses were part of the white-dominated health system that ultimately marginalized the lay midwives. But it does not fully explore the extent to which nursing's holistic focus may be compatible with the midwives' community-oriented vision. The exhibit does profile one current African-American nurse-midwife. And it suggests that the lay midwives' strong commitment to the common good offers important lessons for today's troubled society, presumably including health workers. To that end, the exhibit urges a renewal of African-American midwifery. On the whole, "Reclaiming Midwives" is a valuable look at an under-recognized group of health providers who really were "pillars" of their communities. Sound familiar?

The exhibit explores the key role lay midwives played in the lives of African-Americans in the South, from the earliest days of slavery until well into the 20th century. Pre-Civil War midwives, who learned through apprenticeship, had an unusual status. Some traveled to different plantations to care for new mothers--including white women. Some bought their freedom with the money they earned. Some were addressed as "nurse," "doctor," or "doctoress."

After the Civil War, the exhibit notes, African-Americans were still excluded from nursing and medical schools. Lay midwives continued their work in the underserved black community. Some families spawned generations of midwives. The exhibit shows that spirituality was critical to the midwives' work. Many felt called to practice by dreams and signs, and their midwifery included rituals and practices traceable back to Africa. The spiritual nature of their work reportedly led many to be very flexible about payment.

What exactly did the midwives do? They delivered babies in homes, but they also provided extended after-care, helped the sick, and promoted overall wellness through spiritual and herbal treatments. They were seen as wise community leaders. The exhibit includes a number of photos, objects, and video materials to illustrate some aspects of their work. After birth, midwives would return for weeks to care for mother and baby, and to help with child care and household tasks. Midwives celebrated the birth and aimed to protect the mother. They buried the placenta, kept a fire burning for days after the birth, made sure the house was not swept, placed a sharp item under the mother's mattress, and oversaw a one month period of seclusion, after which they prepared the new mother to rejoin her community.

More detail on the reasons for and actual health effects of the midwives' specific practices might have been helpful. Spirituality and tradition are vital to many communities. But exhibit visitors might wonder about the physiological effects of the midwives' work. Can we associate their practices with health benefits under current scientific models, as is the case for some traditional healing methods? For instance, did the period of seclusion reduce the risk of infection? What were its physical and psychological effects on mothers? What were the likely effects of the unswept floor? Also, did the midwives' practice constantly evolve, based on close observation--like science--or was it slower to change, perhaps because of the power of traditions and enduring beliefs? How did the midwives' care compare to that of nurses and physicians of the time?

The exhibit explains that starting in the 1920's, state governments began to regulate the midwives' practices, often in insensitive ways, as part of new public health programs. Midwives reported to local health departments, and specifically to public health nurses, who assessed their homes, their care bags, and their moral character. The midwives reported the names of the mothers they planned to help, and apparently needed advance approval from physicians to give that help. However, this new regulatory attention did not come with significant support for further training of midwives. The exhibit might have done more to explain why the government distrusted the midwives. Was it basic racial, cultural, and/or credentialist bias? Did regulators have concerns about specific midwife practices?

Midwives reacted in various ways to the new attention. Some quit, but others continued their traditional practice, while complying with the new rules, or at least seeming to do so. The exhibit reports that even in 1950, midwives may have cared for as many as half of the black babies born in some Southern states.

Part of the exhibit focuses on a 1952 midwife training film called "All My Babies: A Midwife's Own Story." According to the exhibit, this film is as an unusual example of media that taught lay midwives in a respectful way, and it was used as far away as India. Produced by the Association of American Medical Colleges and the Georgia Health Department, the film features Georgia midwife Mary Francis Hill Coley. The exhibit says that Coley instilled confidence and endurance in the many new mothers she helped. A respected church figure, Coley also reportedly helped to bridge the gap between the white-dominated state health system and the African-American community. The exhibit includes powerful images of Coley from the film.

The final part of the exhibit, entitled "Survivors," explains that by the 1970's few of the traditional midwives remained. It suggests that this was due to the intentional efforts to eliminate the midwives, and also cultural and technological changes, including the increasing entry of Southern black women into obstetrics. The exhibit might have explained more fully just what these women have been doing in obstetrics, and what does remain of African-American midwifery, perhaps with examples. Obviously certified lay midwives do practice today throughout the nation. Do today's lay midwives incorporate many of the traditional practices? The exhibit does say that there have been other recent efforts to celebrate the achievements of the traditional midwives, several of which it highlights. And it expresses the hope that this may contribute to a renewal of African-American midwifery.

The exhibit does not fully explore the relationship between the lay midwives and nurses. Obviously, nurses were part of the establishment structure that subjected the lay midwives to increasing regulation. Yet nursing's holistic focus would seem to be compatible, at least to some extent, with the approach of the midwives. And nursing would be a potential vehicle for the midwives to gain further scientific training, at least once they were allowed to attend nursing school. Indeed, the exhibit is supported by the American College of Nurse-Midwives (ACNM). The ACNM press release promoting the exhibit highlights the exhibit's profile of local certified nurse-midwife and ACNM fellow Marsha Jackson. However, the exhibit does not seem to address in much depth the mixed relationship between the lay midwives and nurses, or discuss in detail the role nursing might play in a revival of African-American midwifery.

The companion art exhibits reflect the experience of African-American women and children. "Mother and Child: Expressions of Love" celebrates the maternal-child bond through various media from recent decades. "Conversation Among Blues Women" is a mixed media installation centered on masks of local African-American women, "blues women" who seek an empowering link between the past and the future. And "Reflections: Life Pieces to Masterpieces" collects canvases from a local arts organization that challenges young African-American males to celebrate life and confront difficult social issues with creative activities.

"Reclaiming Midwives" is an interesting and important look at traditional African-American midwives. It might have explored the midwives' complex relationship to nursing in more detail. But for those with an interest in nursing today, it may serve as both inspiration and a cautionary tale, the story of vital health workers whose contributions were not recognized by prevailing power structures until almost none of the workers remained.

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Reviewed by Harry Jacobs Summers
Nursing Editor: Sandy Summers, MSN, MPH, RN

Last updated: February 14, 2006

The views expressed herein do not necessarily reflect those of the Board Members or Advisory Panel of The Truth About Nursing.